News & Events

PRI’s MPV (Monkeypox) Situation Update – October 4

Oct 4, 2022 | News

Latest editions Tuesday and Thursdays. While we use the language “MPV”, most sources do not, and readers will see the language fluctuate within the report. For questions and feedback, please email info@pri.nyc

Summary

Case Counts/Trends and Large Guidance/Response Changes (Limited by latest reporting)

  • GLOBAL: From 1 January through 18 September 2022, 61 753 laboratory-confirmed cases of monkeypox and 23 deaths have been reported to WHO from 105 countries/territories/areas (hereafter ‘countries’[i]) in all six WHO Regions (Table 1). Since the last edition published on 7 September 2022, 8757 new cases (16.5% increase in total cases) and five new deaths have been reported. In the past seven days, 23 countries reported an increase in the weekly number of cases, with the highest increase reported in Chile. Three new countries also reported their first case in the past seven days: Guam (12 September), Ukraine (15 September), and Bahrain (16 September). Overall, 33 countries have not reported new cases for over 21 days, the maximum incubation period of the disease. (WHO Sit Rep – Latest 9/21/2022 / Dashboard)
  • US: Total confirmed MPV cases: 26,049 (10.03.2022). (full version). 
  • NY State: As of September 21 2022, a total of 3,759 confirmed orthopoxvirus/monkeypox cases – a designation established by the Centers for Disease Control and Prevention (CDC). (NY Sit Rep and County List) 
  • What the AIDS Crisis Can Teach Us About Monkeypox (Boston Review)  The trio urged the government to quickly ease access to testing, deploy vaccines and antivirals held in the Strategic National Stockpile, and consult infectious disease and HIV experts to craft public health messages for queer men. This wasn’t wishful thinking. As epidemiologist, MacArthur “genius” recipient, and ACT UP veteran Gregg Gonsalves recently told PBS NewsHour: “We could have contained this outbreak.
  • ‘4-alarm blaze’: New York’s public health crises converge (Politico) Despite being bolstered by more public health funding per capita than most states, New York public health officials are trying to cope with the threat of three simultaneous disease outbreaks, according to interviews conducted over the last two months with more than six New York state health officials and public health experts.

US Updates/News

  • Monkeypox likely to be continuing threat in US for next few years, says CDC official (Fox News) monkeypox is probably not going away any time soon, according to some U.S. health officials, The Associated Press is reporting. While the disease’s spread is slowing, the monkeypox virus is so widespread that elimination is unlikely, said the Centers for Disease Control and Prevention (CDC). That conclusion was contained in a recent CDC report — and on Friday, Marc Lipsitch, director of science at the agency’s disease-forecasting center, echoed it.

Global Updates/News

  • Vietnam reports first case of monkeypox (Reuters) Health authorities in Vietnam’s Ho Chi Minh City on Monday announced the country’s first case of monkeypox, the state-run Vietnamnet newspaper reported, without giving any details on the patient.
  • Britain is winning the fight against monkeypox, reveals disease expert (The Sun) Cases appeared here in May, peaking at 60 a day in mid-July. The UK has had more than 3,500 cases but fewer than 15 new infections a day in recent weeks.Prof Ferguson’s data was key to the UK going into the first Covid lockdown in March 2020. “We have to be alert to the possibility that once case numbers are much lower and maybe people are less vigilant, then we could start to see a resurgence,” he told the BBC.

Official Guidance Sources

Articles by Category

Epi/Transmission/Mitigation

Perceived concern and risk of getting infected with monkeypox among MSM: Evidence and perspectives from the Netherlands, July 2022 (Wang et al., medRxIv)

This study aimed to investigate this to complement and to help determining if the current measures to curb the epidemic are successfully targeted or not in the Netherlands. Researchers conducted an online survey among 394 Dutch men who have sex with men (MSM). They first calculated the prevalence and standardized prevalence ratio (SPR) of high perceived concern/risk of monkeypox by the PrEP-use and HIV status and then conducted multivariable logistic regression analyses to investigate the perceived concern/risk of monkeypox and the potential socio-demographic/behavioral/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern and 30% showed high perceived risk of monkeypox. PrEP users (SPR=0.83) showed a significantly lower chance of perceived concern; and MSM with HIV (SPR=2.09) were found to have a significant higher chance of perceiving high risk of monkeypox. In the multivariable logistic analyses, non-PrEP users (aOR=2.55) were more likely to perceive high concern, while MSM who were retired (aOR=0.23) and who had chemsex (sex while using crystal meth/tina, GHB, ketamine etc) recently (aOR=0.63) were less likely to perceive high concern. MSM with HIV (aOR=4.29) and MSM who had an unknown/undisclosed HIV status (aOR=6.07) who had attended private sex parties (aOR=2.10) and who knew people who have/had monkeypox (aOR=2.10) were more likely to perceive high risk of monkeypox. Researchers found that a higher perceived risk (aOR=2.97) and a higher concern (aOR=3.13) of monkeypox were correlated with each other (for more results see Table 2 in the article). In summary, only one-third of Dutch MSM considered themselves at a high risk of a monkeypox infection, and only half of them showed a high concern. The authors identified a potential discrepancy between the “actual risk” and the perceived risk and concern of monkeypox among MSM in this early stage of the monkeypox epidemic in the Netherlands, especially among PrEP users and MSM with HIV.

Viral loads in clinical samples of men with monkeypox virus infection: a French case series (Palich et al., The Lancet)

Monkeypox virus (MPXV) is currently spreading among men who have sex with men, outside of sub-Saharan Africa, and close contact during sex seems to be one of the key pathways of viral transmission in the current outbreak. Our aim was to describe the distribution of MPXV in the human body, as it might play a role in its dissemination through sexual contact. The study population in this case series consisted of patients with confirmed MPXV infection attending the Pitié-Salpêtrière Hospital (Paris, France), who had been sampled from multiple anatomical sites, including skin, anus, throat, blood, urine, and semen, at diagnosis and 2 weeks later. We compared the proportion of positive samples and MPXV viral loads (given as PCR cycle thresholds [Ct]) between anatomical sites, and between day 0 (D0) and D14. Overall, 356 samples were collected between May 20 and June 13, 2022, from 50 men with a median age of 34 years (IQR 29–40). 22 (44%) of the 50 men were classified as HIV-negative on day (D)0, and 22 (44%) were living with HIV. At D0, MPXV detection was more frequent from skin (44 [88%] of 50), anus (30 [71%] of 42), and throat (36 [77%] of 47) than from blood (13 [29%] of 45), urine (nine [22%] of 41), or semen (13 [54%] of 24). Viral loads were significantly higher from skin lesions (Ct 19·8) and anal samples (Ct 20·9) than from throat (Ct 27·2), blood (Ct 32·8), urine (31·1), or semen samples (Ct 27·8). When analysing the 107 samples taken from 24 patients at D14, the proportion of positive samples strongly decreased between D0 and D14 at all sites: skin (four [22%] of 18), anus (two [9%] of 22), throat (none of 21), blood (one [5%] of 21), urine (none of 14), and semen (two [9%] of 11). These data contribute to a better understanding of how the virus might spread between sexual partners over a relatively short period of time. High MPXV viral loads from skin and mucosa, including genital and anal sites, suggest that transmission most likely occurs through direct body contact rather than through the respiratory route or contact with body fluids, which should help to refine the prevention messages delivered to individuals most exposed to the virus.

On nonlinear dynamics of a fractional order monkeypox virus model (El-Mesady et al., Chaos, Solitons & Fractals)

In this work, we examine a fractional-order model for simulating the spread of the monkeypox virus in the human host and rodent populations. The employment of the fractional form of the model gives a better insight into the dynamics and spread of the virus, which will help in providing some new control measures. The model is formulated into eight mutually exclusive compartments and the form of a nonlinear system of differential equations. The reproduction number for the present epidemic system is found. In addition, the equilibrium points of the model are investigated and the associated stability analysis is carried out. The influences of key parameters in the model and the ways to control the monkeypox epidemic have been thoroughly examined for the fractional model. To ensure that the model accurately simulates the nonlinear phenomenon, we adapt an efficient numerical technique to solve the presented model, and the acquired results reveal the dynamic behaviors of the model. It is observed that when memory influences are considered for the present model, through Caputo fractional-order derivatives, they affect the speed and time taken by solution trajectories towards steady-state equilibria.

Monkeypox Diagnosis by Cutaneous and Mucosal Findings (Sousa et al., Infectious Disease Reports)

A monkeypox outbreak has been reported in several countries since early May 2022. Human monkeypox (MPX) diagnosis is based on a clinical suspicion supported by typical skin and mucosal lesions, confirmed with molecular testing. We present the results of all MPX confirmed patients presenting to our department until July 15 of 2022, describing the characteristics of the lesions at diagnosis. In total, 47 patients were included, all men and 44.7% (n = 21) were HIV-positive. Skin lesions were noted in all patients. The most commonly affected area was the genital region (63.8%), followed by the anorectal region (46.8%). Extra anogenital mucosal (oral or conjunctival mucosa) involvement was reported in three patients. Typical skin findings included erythematous papules, whitish, umbilicated papules, some with a necrotic center and an elevated whitish border. Most patients had lesions in multiple phases presenting simultaneously. Correct identification of MPX skin and mucosal lesions is crucial to avoid late diagnosis and prevent further spreading, ensuring less worldwide morbidity.

The first imported case of monkeypox in Taiwan (Huang et al., Journal of the Formosan Medical Association)

The first imported case of monkeypox in Taiwan was diagnosed in an Asian man with HIV-1 infection and asymptomatic COVID-19, returning from Germany. Atypical presentations included asynchronous skin lesions, anogenital lesions and prominent inguinal lymphadenopathy. Whole genomic sequence alignment indicate that the Taiwan strain clustered together with human monkeypox virus West African clade B.1, currently circulating in Europe. Prompt diagnosis and infection control measures are crucial to mitigate the spread of monkeypox. Monkeypox is a viral zoonotic disease of global public health importance caused by monkeypox virus (MPXV), belonging to the Poxviridae family, Orthopoxvirus genus and first reported in Central and West Africa. It emerged recently to cause a global outbreak in 50 countries worldwide. Up to June 22, 2022, 3413 laboratory confirmed cases have been reported to the World Health Organization (W.H.O.), with 86% of the cases from the WHO European region, including the United Kingdom (793 cases), Germany (521), Spain (520), Portugal (317), France (277), the Netherlands (167) and others.1 By Aug 19, 2022, the number of cases reported worldwide increased to 41,358 in 94 countries, including Taiwan (3), Singapore (15) and South Korea (1). Human-to-human transmission occurred among people in close physical contact with individuals who are symptomatic. Cases were mainly identified amongst men who have sex with men (MSM), without a travel history to endemic regions, who sought care in primary care and sexual health clinics. At the time our case was first diagnosed, only two cases has been identified in Asia, one in Singapore on June 20, and one from South Korea on June 22.1 W.H.O. convened an Emergency Committee for monkeypox on June 23, 2022 and assessed that the current outbreak does not represent a public health emergency of international concern, but advised that intense efforts are required to control further spread. The Taiwan Centers for Disease Control (C.D.C.) placed out an alert to first-line doctors on May 22, 2022, and listed monkeypox as a category 2 notifiable communicable disease on June 23, 2022. We report the first imported case of monkeypox in Taiwan in an Asian man, with HIV infection and asymptomatic COVID-19, returning from Germany.

Is monkeypox airborne? (Lauren, Canadian Medical Association Journal)

Debate about whether monkeypox is airborne has trended on social media since the early days of the global outbreak, echoing a similar controversy from the first two years of the COVID-19 pandemic. It took the World Health Organization (WHO) until the fall of 2020 to acknowledge that SARS-CoV-2 could spread through respiratory droplets, and two years before the agency quietly updated its website to state that airborne transmission can occur. Critics say WHO’s reluctance to acknowledge the possibility of airborne transmission undercut support for important precautions like masking and ventilation. And although public health officials are less cagey about the possibility of airborne transmission with monkeypox, misunderstandings about the difference between airborne and respiratory transmission have contributed to confusion.

Vaccine

Monkeypox: Emerging virus of concern; antivirals and vaccines therapeutic options (Obeid at al., Microbial Pathogenesis)

The detection of >400 Monkeypox virus cases in the month of May 2022 and increase to 57,527 confirmed cases by September 9th, 2022, across the world, emphasizes the need of new therapeutics for this emerging viral epidemic in humans. Largely the cases seen in Europe, Australia and America are among men who have sex with men making transmission through intimate contact with infectious skin lesions the likely mode of transmission. This implies that this high human-to-human transmission observed in the young Caucasian clusters, and the probable community transmission without any history of travelling to endemic areas would suggest that the epidemic is likely to be sustained human-to-human transmission and unlikely one that would be a short-lasting epidemic. This might necessitate the need for new therapeutic approaches and agents for prophylaxis and treatment of acute infections which is the focus of this review article.

Virology

Development of a Loop-Mediated Isothermal Amplification Method for Rapid and Visual Detection of Monkeypox Virus (Feng et al., American Society for Microbiology)

Monkeypox virus (MPXV) is a human pathogenic virus that belongs to the genus Orthopoxvirus. In 2022, MPXV caused an unprecedented number of infections in many countries. As it is difficult to distinguish MPXV from other pathogens by its symptoms in the early stage of infection, a rapid and reliable assay for MPXV detection is needed. In this study, we developed a loop-mediated isothermal amplification (LAMP) assay for the specific detection of MPXV and evaluated its application in simulated clinical samples. The

A27L-1 and F3L-1 primer sets were identified as the optimal primers, and 63°C was the most appropriate reaction temperature for sequence amplification. The detection limits of the LAMP assay using primer sets A27L-1 and F3L-1 were both 20 copies/ reaction mixture, which were .100-fold higher in terms of sensitivity, compared with conventional PCR. The LAMP assay findings were negative for all 21 non-MPXV pathogens, confirming the high specificity of our assay. All three types of simulated clinical samples were clearly identified by our LAMP assay, and the detection limits were consistent with the sensitivity results, indicating efficient clinical sample identification. Our rapid and reliable MPXV LAMP assay could be useful for MPXV detection and on-site diagnosis, especially in primary hospitals and rural areas.

More News